Anthem Blue Cross and Blue Shield of Wisconsin
Wisconsin • EPO, PPO, Medicare Advantage
EPO (Exclusive Provider Organization) plans require members to use in-network providers, similar to an HMO. The key difference is that referrals are usually not required to see a specialist. Out-of-network care is not covered except in emergency situations. Submit claims to the payer listed above.
Under this PPO prefix, members are covered for both in-network and out-of-network care. The plan pays a higher percentage of allowed charges when members use participating providers. No gatekeeper or primary care referral is required. Verify the member's specific benefits for cost-sharing details.
This prefix is associated with Medicare Advantage. MA plans combine hospital (Part A) and medical (Part B) coverage, and many include prescription drug coverage (Part D). When billing, confirm whether the plan uses the same payer ID for MA claims as for commercial claims, as many BCBS companies use separate IDs.
Independent licensee providing commercial, Medicare and Medicaid plans to Wisconsin members.